Auditor calls on NHS to improve payments coding

In a report published on 26 August 2010, the commission says it has identified some £9m of financial errors due to incorrect clinical coding used to identify how NHS trusts are paid for treatment. The errors are most relevant to data on health resource groups (HRGs), which bring together clinically similar treatments that are judged to consumer a similar amount of resources. The situation has improved, however. "When we started the audits in 2007-08, on average, 16.5% of diagnosis and procedures were not accurately coded," says the document. "In 2009-10, on average, 11.3% of diagnosis and procedure coding was inaccurate." Despite the overall improvement, the actual error rate for the HRG increased in 2009-10 because most Payment by Results tariffs moved to new and more complex set of Health Resource Groups, known as HRG4. Over the past three years the commission has carried out random sample audits on four specialities - general medicine, trauma and orthopaedics, cardiology and paediatrics - at all trusts that deliver them. The commission has estimated that £1bn of the £21bn expenditure, or 5%, in these four specialties was paid on the wrong HRG between 2007-08 and 2009-10. Nationally, primary care trusts were not over or undercharged for the work, however, because the average net financial error rate is less than 0.5% in the four specialities audited. The report goes on to say that, despite the overall improvement in clinical coding, there are significant variations between the best and worst performing trusts. HRG error rates range between 0 and 28% and the clinical coding error rate range is similar. Its key recommendations for improvement are: - regular internal audits on clinical coding and the quality of outpatient data; - clinical coders to be well trained and follow national standards; - clinicians to be engaged in improving the accuracy of inpatient and outpatient data; - up to date policies and procedures for data quality; and - source documentation to be of a good quality, accurate and readily accessible to those inputting data. "Our work has highlighted problems in the consistency and interpretation of national guidance and definitions that affect data quality," says the commission. "We will work this year on specific data definition issues with the NHS and key partners to look at how these can be resolved."